FREE AND STUDY GAMES ABOUT MANAGED CARE EXAM

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FREE AND STUDY GAMES ABOUT MANAGED CARE EXAM

QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -122 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: requires little financial commitment

Answer:

Alliances

Question 2: Types of integration

Answer:

Integration based on major participants Integration based on ownership or affiliation Integration based on service consolidation

Question 3: As managed care grew, what occurred

Answer:

competition among MCOs gave rise to new forms of managed care plans

Question 4: Acquisition

Answer:

purchase on one organization by another

Question 5: 3 types of utilization review

Answer:

Prospective utilization review concurrent utilization review retrospective utilization review

Question 6: Types of MCOs

Answer:

HMOs PPOs Point-of-Service Plans (POS)

Question 7: What are commonly in the form of managed care plans

Answer:

HDHPs

Question 8: What is a major selling point for POS plans

Answer:

Free choice of providers Question 9: Integrating physicians into large organizations: Easy or challenging?

Answer:

challenging

Question 10: Main objectives of prospective utilization review

Answer:

to prevent unnecessary or inappropriate institutionalization or txs such as surgery

Question 11: Utilization review

Answer:

process of evaluating the appropriateness of services provided

Question 12: PHO is what

Answer:

alliance b/t physicians and hospitals--together they have greater bargaining power w/ MCOs

Question 13: Accountable care organizations are authorized under what

Answer:

ACA of 2010

Question 14: Point-of-Service plans (POS) combine what features

Answer:

HMOs w/ patient choice found in PPOs

Question 15: integrated system was formed in response to what

Answer:

growing power of managed care-- became a rational choice for the survival of small providers Question 16: Which HMO model has been the most successful in terms of enrollment

Answer:

Independent Practice Association (IPA) model

Question 17: Gatekeeping emphasizes what

Answer:

preventive care, routine physical exams, and other primary services

Question 18: In the U.S. primary responsibility for cost containment falls on?

Answer:

the private sector

Question 19: what has experienced unprecedented success

Answer:

managed care

Question 20: Utilization control methods in managed care

Answer:

Gateskeeping Utilization Review--prospective utilization, concurrent utilization, retrospective utilization reviews

Question 21: The CMS rates Medicare Advantage (part

• on what?

Answer:

1 to 5 star scale using indicators such as:

-quality of care -access -responsiveness -beneficiary satisfaction

Question 22: Integration based on ownership or affiliation

Answer:

Acquisitions and mergers joint ventures alliances virtual organizations

Question 23: Focus on illness rather than wellness

Answer:

Lucrative for physicians to hospitalize pts

Question 24: Most common example of concurrent utilization review

Answer:

monitoring the length of inpatient stays Question 25: Which HMO model exercises greater control over practice patterns and can better monitor utilization

Answer:

Staff Model Question 26: HMOs: Group model contracts w/ what

Answer:

w/ a multispecialty group practice and separately w/ one or more hospitals, to provide comprehensive services to its members